A 2-year-old child is admitted to the pediatric unit with severe diarrhea and dehydration. The child has had 8-10 watery stools in the past 24 hours and shows signs of moderate dehydration. What is the priority nursing intervention for this child?
1Administer anti-diarrheal medication to reduce stool frequency
2Initiate oral rehydration therapy with small, frequent amounts of electrolyte solution✓ 정답
3Provide BRAT diet (bananas, rice, applesauce, toast) immediately
4Collect stool specimen for culture and sensitivity testing
해설
Oral rehydration therapy is the priority for moderate dehydration as it safely restores fluid balance. Anti-diarrheals may delay toxin clearance, BRAT diet lacks nutrition, and stool culture is not urgent.
Clinical Judgment
The core of this problem is priority setting. The child is in a state of moderate dehydration, and the most urgent physiological need is restoring fluid and electrolyte balance. In the 'Recognizing' phase of the Clinical Judgment Measurement Model (CJMM), 8–10 episodes of watery diarrhea within 24 hours indicate significant fluid loss. In the 'Analyzing' phase, since moderate dehydration allows for oral intake, the safest and most effective first-line treatment is oral rehydration therapy (ORT). In the 'Prioritizing' phase, all other interventions are considered only after this basic physiological need is addressed.
KR vs US:
In Korea, the use of oral rehydration solutions (ORS) for acute diarrhea is becoming more common, but there may still be a higher reliance on IV fluids or antidiarrheal medications. The American Academy of Pediatrics (AAP) and WHO strongly recommend ORT as the primary and standard treatment for children with moderate dehydration who can tolerate oral intake. This is a non-invasive, cost-effective approach that reduces the need for hospitalization and intravenous access.
Clinical Practice Guide
Signs of moderate dehydration: dry oral mucosa, decreased tears, overall reduced activity, decreased skin turgor when pinched, decreased urine output, etc.How to perform ORT: Use a commercial electrolyte solution (Pedialyte, Enfalyte, etc.) or WHO-recommended ORS. Start with 5-10 mL (one spoonful) every 5-10 minutes, and gradually increase the amount if tolerated well without vomiting. Aim for 50-100 mL per kg of body weight within 4 hours.
Caution:
In SATA (Select All That Apply) questions asking for "priority interventions," diagnostic tests (stool culture) or symptom-relieving treatments (antidiarrheals) may be included. Always choose interventions that address ABC (Airway, Breathing, Circulation) and basic physiological needs (fluids) first. The BRAT diet can be considered during the gradual return to a regular diet after correcting dehydration, but it is not an initial or standalone treatment.
Dehydration — A condition where excessive loss of body water disrupts physiological functions. In children, it can progress rapidly.
Oral Rehydration Therapy — A treatment that supplies electrolytes and fluids through the mouth. It uses the sodium-glucose cotransport mechanism in the small intestine for efficient absorption.
Watery Diarrhea — Watery, loose stools caused by increased intestinal secretion or osmotic effects. Leads to rapid loss of water and electrolytes.
Moderate Dehydration — A state where approximately 6-9% of body weight in fluids has been lost. Clinically, dry mouth, decreased tear production, reduced skin turgor, and decreased urine output are observed.
Electrolyte Solution — A solution containing appropriate concentrations of sodium, potassium, chloride, glucose, etc. It replenishes electrolytes lost due to diarrhea and promotes water absorption.